Spondylosis describes the degenerative changes within vertebrae and intervertebral discs that occur during ageing or secondarily to trauma or rheumatoid disease. The changes are common in the lower cervical and lower lumbar region.
Several, often related, factors are important in producing signs and symptoms, including:
• Osteophytes-local overgrowth of bone
• Congenital narrowing of the spinal canal
• D

Weakness is the predominant feature of a myopathy. Its distribution and pattern is of diagnostic importance. A classification of muscle disease is given in Table 18.56. Only the more common conditions are mentioned below.
PATHOPHYSIOLOGY
Muscle fibres are affected by:
1 Acute inflammation and fibre necrosis (e.g. polymyositis)
2 Chronic degeneration of muscle fibres (e.g. Duchenne muscular dystrophy)
3 Regener

This is a rare non-metastatic manifestation of small-cell carcinoma of the bronchus. There is defective acetylcholine release at the neuromuscular junction. Proximal muscle weakness, sometimes involving the ocular and bulbar muscles, is found, with absent reflexes. Weakness tends to improve after muscular contraction (unlike myasthenia gravis).
Other myasthenic syndromes Other rare myasthenic syndromes occur

The different nerve fibre types within a peripheral nerveare shown in Table 18.49. All are myelinated except the C fibres, which carry impulses from painful stimuli. Two pathological processes affect peripheral nervesaxonal (the axon itself) degeneration and demyelination(the myelin sheath). Neuropathies are classified broadly into which of the two processes predominate. Wallerian degeneration refers to the

The face is richly supplied with pain-sensitive structures the teeth, gums, sinuses, temporomandibular joints, jaw and eyes-disease of which causes facial pain. Facial pain is also caused by some specific neurological conditions; these are mentioned below.
Migrainous neuralgia (cluster headache)
This condition, which is distinct from migraine despite its name, causes recurrent bouts of excruciating pain that

There are 200-300 admissions annually for head injuryper 100000 population in most Western countries: 10 people per 100000 die annually and the prevalence of survivors with a major persisting handicap is of the order of a 100 per 100 000. Road traffic accidents and alcohol abuse are the principal aetiological factors in this major cause of morbidity and mortality.
Skull fractures
Linear skull fracture of the

The cord extends from Cl (its junction with the medulla) to the vertebral body of Ll (the conus medullaris). The blood supply is via the anterior spinal artery and a plexus on the posterior cord. This network is supplied
by the vertebral arteries, the thyrocervical trunk and several branches from the lumbar and intercostal vessels. Spinal cord compression The principal features of cord compression are of radi

The term ‘degenerative’ underlines a present lack of understanding of the aetiology of this group of progressive diseases of the nervous system.
Motor neurone disease (MND) In this disease there is progressive degeneration of motor neurones in the spinal cord, in the somatic motor nuclei of the cranial nerves and within the cortex. The condition is sporadic and of entirely unknown cause. Though no